Random inspection report
Care homes for older people
Name: Address: Ashmount Residential and Nursing Home 10 Southey Road Worthing West Sussex BN11 3HT one star adequate service 14/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Suni Chotai Date: 1 8 0 1 2 0 1 0 Information about the care home
Name of care home: Address: Ashmount Residential and Nursing Home 10 Southey Road Worthing West Sussex BN11 3HT 01903528500 01903528502 ashmount@guildcare.org www.guildcare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Hall Type of registration: Number of places registered: Conditions of registration: Category(ies) : Guild Care care home 50 Number of places (if applicable): Under 65 Over 65 50 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Ashmount is registered to provide personal and nursing care for up to fifty people aged 65yrs and over. It is a large detached property situated in a residential area of the seaside town of
Care Homes for Older People Page 2 of 9 1 9 1 1 2 0 0 9 Brief description of the care home Worthing. The sea front and shopping areas are a short walk away. There is a private car park at the front of the home and a garden at the back. Accommodation is provided on 3 floors. A passenger lift allows access to all floors. Large communal sitting and dining areas are available on the ground floor. Fees are between #259 and #460 per week. Care Homes for Older People Page 3 of 9 What we found:
Suni Chotai, Pharmacist inspector visited the home to check compliance with two Statutory Requirement Notices served in December 2009. One Statutory Requirement Notice required the home to do the following in relation to regulation 12 of the Care Standards Act by 4/1/10: 1. To have a system in place that checks and records all medication received into the Home, ensuring that service users prescribed medication is available at all times. The system must include the actions staff are to take when requested medication is not provided by chemist or doctors surgery. We saw that during the period observed two residents were left without their medicine. One person was not given a medicine at lunchtime as it was delivered a little after lunch on the 4/01/10. The other resident was left without medicine for a period of 2 and a half days. There was evidence in the home in the form of faxes to request this medicine and reminders to staff in the diary to chase up the delivery of this medicine. The home had taken steps to order this medicine. It is noted that this occured when the country had severe weather conditions and it is accepted that the pharmacy may have had difficulty getting medicine to the home over that time. We noted that with this medicine there is an existing problem with supplies at the start of the month in that not enough is received to cover the 28 day cycle. It is the homes responsibility to ensure medicines are available for continuity of treatment. From the evidence gathered we conclude that this notice has not been met. The second statutory notice served in December 2009 related to regulation 13 of the Care Standards Act and required the service to: 1. Have a medication policy and procedure in place that conforms to the Royal Pharmaceutical Society guidance the handling of medicines in social care and National Minimum Standards. This policy must be fully implemented and complied with by all staff. We saw the policies and procedures that were local to the home. These gave guidelines to staff on the procedures in the home in various aspects of medicine management. In addition we saw that new procedures had been implemented to address recent concerns around ensuring supplies are in stock for continuity of treatment. 2. Assess all staff who have the responsibility for administering and handling medication, as to whether or not they are competent to do so. You must take appropriate action, such as providing training and suspension from handling medicines, for those who do not achieve the required level of competency. The assessment must be conducted by an appropriately experienced and qualified person. We were informed that there had been recent training from the local pharmacy. We saw a memo to staff requesting that there was an expectation that all staff attend this training in light of recent difficulties. When asked about supervision to assess competence, we were informed that there is regular informal supervision on an ongoing basis when staff
Care Homes for Older People Page 4 of 9 give medicines. From documentation we noted that staff followed good practice and had a good understanding of medicines however the home were not able to evidence that staff had attended the training nor that formal competency assessment had been undertaken. 3. Ensure a system is in place to ensure all medication is administered in accordance with the prescribers instructions. You must have a system in place to monitor both the repeated refusal of medication and the requests for additional medication, such as pain relief. This system must include the need to consult the prescriber and request a review of medication. On our last visit we noted many medicines for external use on the MAR charts which were not being used. These have been reviewed and removed from the chart. We saw for one resident, evidence of medicine which was repeatedly refused had been reviewed. 4. Ensure you provide clear written guidance to staff for each service users who is prescribed as required PRN, medication and variable dosages, as to when to administer the medication and any triggers or indicators known that shows the medication is needed. You must maintain records of; date, time, dose, service user name, what medication was administered and reason for administration. Clear and detailed care plans were seen for medicine prescribed to be taken only when needed. The records for when such a medicine was given clearly documented the time, the amount given and the effect seen. 5. Have a system in place that accurately records all medication that is administered, including: service user name, medication name, the dosage, the date, the times, reason for refusal or unable to take medication and the signature of the person recoding the administering and/or refusal of the medication. All medicines given to people were signed for. Any refusals were recorded and we noted that records were completed and accurate. 6. Ensure that prescribed lotions and creams are administered at the times and amounts that has been prescribed and a record is kept. When a course of treatment has been completed, a consultation with the prescriber must take place if the symptoms reoccur. You must not recommence treatment after a break in that treatment without seeking medical advice first. All medicines listed on the MAR charts were current and were being given. The Manager of the service had only seen one of the SRN served and we confirmed by telephone that the other SRN was received at head office but not passed onto the manager of the home. The evidence gathered shows that improvement has been made and this second Statutory requirement notice relating to regulation 13 is considered as met. Whilst we were in the home we noted that unwanted medicines are sent back to the supplying pharmacist. We informed the manager to ensure that the supplying pharmacist is licensed to do so. Care Homes for Older People Page 5 of 9 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 15 Sch 3 (1)(b) The registered person must ensure that residents have clear individual care plans describing the support that staff give to meet identified needs. To ensure that individual needs are met safely 14/11/2009 2 9 12 12 The registered person 14/11/2009 must ensure that medication that has been prescribed is available for the individual. This will ensure that the individual receives the correct medication and helps to monitor their health. Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
